Elsevier

Academic Radiology

Volume 10, Issue 3, March 2003, Pages 266-274
Academic Radiology

Process Utility for Imaging in Cerebrovascular Disease

https://doi.org/10.1016/S1076-6332(03)80100-9Get rights and content

Abstract

Rationale and Objectives

The morbidity associated with a diagnostic test can influence its cost-effectiveness, but the quantification of that morbidity is controversial. Accounting for pain and invasiveness requires the measurement of “process utility” in addition to the expected value of testing. An original time trade-off variant was applied to the imaging evaluation of cerebrovascular disease, for which differences in morbidity are important to patients.

Materials and Methods

A “waiting trade-off” (WTO) was used to evaluate the preferences of 89 patients for magnetic resonance (MR) angiography and conventional x-ray angiography. Patients were experienced with both tests. A weighted difference was calculated between the period a patient was willing to wait for a test result and treatment after a hypothetical “ideal” test and the choice to undergo conventional angiography or MR angiography with immediate treatment. A rating scale was used to check the convergent validity of the WTO.

Results

Paired data showed a highly significant difference (P = .0001 between the mean preference for conventional and MR angiography, favoring the latter and translating into a difference of 5 quality-adjusted life days. The more negatively patients judged their conventional angiographic experience, the longer they were willing to wait for the ideal test result.

Conclusion

The WTO provides a reasonable estimate of the relative morbidity of more invasive conventional angiographic procedures and provides a quality-adjustment term for economic analysis. Such an approach may enable more complete evaluation of the effects of other processes on medical care.

Section snippets

Materials and Methods

All patients had undergone both MR and conventional angiography in the recent past as part of a diagnostic work-up for possible cerebrovascular disease. Patients referred for MR imaging or MR angiography and conventional angiography because of likely stroke-related problems (from any origin) at the time of their original diagnostic work-up were eligible for this study. They were recruited within 6 months of the MR and conventional angiographic examinations, having been identified by means of

Results

Forty-seven female and 43 male patients were enrolled in the study. The age range was 18–78 years, with a mean of 54 years and a median of 57 years. Thirty-seven patients were accrued from one university medical center, and the remaining 53 were enrolled from another academic institution in a neighboring state. The principal investigators were faculty at these institutions. One patient was excluded who could not comprehend the tasks. Thus, 89 patients were included in the final analysis.

Discussion

Our results suggest the WTO is successful in deriving a measure of process utility, even in the assumed environment of a more acute medical testing situation than previously investigated in patients with peripheral vascular disease (15). The main strength of the technique seems to be its easily understood approach, which provides a reasonable context for the subject, as well as a metric based on quality-adjusted life years. Our results confirmed our hypothesis that, on average, the more

References (26)

  • BR Luce et al.

    Estimating costs in cost-effectiveness analysis

  • JM Hrung et al.

    Cost-effectiveness of MR imaging and core-needle biopsy in the preoperative work-up of suspicious breast lesions

    Radiology

    (1999)
  • Cited by (28)

    • Developing a Patient-Centered Radiology Process Model

      2016, Journal of the American College of Radiology
      Citation Excerpt :

      Capturing the patient experience will inevitably involve extensions of methods that have been used for measuring health-related quality of life. Swan et al [5-8] evaluated short-term morbidities of catheter angiography, MR angiography, and breast biopsy as well as the treatment of uterine fibroids. The approach to measurement involved visual analog scales (VASs), which are instruments with the appearance of a thermometer that are widely used for assessing attitudes and preferences (see Fig. 1 and Appendix 1), as well as more cognitively demanding techniques such as time trade-off and a variant called the waiting trade-off [5], which determines how long a patient is willing to wait for the results of a hypothetical painless and riskless procedure in order to avoid an actual, potentially noxious procedure that provides the same diagnostic information immediately.

    • Comparing morbidities of testing with a new index: Screening colonoscopy versus core-needle breast biopsy

      2015, Journal of the American College of Radiology
      Citation Excerpt :

      The National Institute for Health and Care Excellence in the United Kingdom now allows the submission of such process-related data in evaluating health care programs as of its 2013 guidelines [7]. An aspect of interest in medical care process utility is the morbidity of the diagnostic testing or screening experience [8-12]. A recently developed instrument called the Testing Morbidities Index (TMI) is available to quantify the disutility toll from any diagnostic or screening procedure [13,14].

    • Patient-centered outcomes in imaging: Quantifying value

      2012, Journal of the American College of Radiology
      Citation Excerpt :

      Swan et al [8,9] have written extensively on the methodology for measuring quality-of-life effects of diagnostic and screening tests, whose effects are temporary but profoundly influence the patient experience. These effects of increased invasiveness and associated discomfort have been shown to differentiate patient preferences for competing tests in cerebrovascular disease [10], breast biopsy [11], and imaging-guide fibroid treatment [12]. One of the most salient uses of diagnostic imaging is in screening for cancer.

    • The Economic Burden of Incidentally Detected Findings

      2011, Radiologic Clinics of North America
      Citation Excerpt :

      Thus, the impact of incidental findings on a strategy’s underlying value can be evaluated explicitly. Importantly, quality of life (QOL) is an integral component of economic analyses in medicine but has been sparsely studied to date in imaging practices.38–41 The rationale for incorporating QOL into economic analyses in medicine and for adjusting life expectancy estimates to incorporate QOL (eg, quality-adjusted life years) is that to estimate how a society values health care services, the value that a society places on time spent in different states of health must be considered.35

    • Measuring the Quality-of-Life Effects of Diagnostic and Screening Tests

      2009, Journal of the American College of Radiology
      Citation Excerpt :

      A potential limitation of WTO is that people may be less willing to hypothetically wait for the ideal test in an acute medical setting, thus confounding measurements of utility. Therefore, we evaluated cerebrovascular MRA vs XRA for stroke evaluation [32] to test if the WTO could discriminate MRA vs XRA test utility in a more acute setting. The WTO demonstrated sensitivity in that results indicated substantial XRA disutility (n = 89 patients).

    View all citing articles on Scopus

    Supported by grant 1R01HS10277 from the Agency for Healthcare Research and Quality.

    View full text